【摘要】 慢性病共病患者常联合使用多种药物，疾病与药物之间潜在的复杂相互作用使全科医生面临着难以合理评估共病药物治疗获益与风险的决策困境。本文以1例在社区卫生服务中心就诊的慢性病共病患者为例，展示和阐述了全科医生运用共病药物治疗决策框架进行科学决策的过程，并基于阿里阿德涅原则为共病管理过程提出的多阶段目标，分析了全科医生在评估、沟通与制定治疗方案等方面的要点和注意事项。希望本文可以为改善社区慢性病共病药物治疗决策的质量提供借鉴。

    【关键词】 慢性病共病；接诊；全科医生；药物治疗决策；病例报告

    【中图分类号】 R 36 【文献标识码】 A DOI：10.12114/j.issn.1007-9572.2024.0273

    Medication Decision-making for Patients with Multimorbidity——Study on Medical Records in Consultation of General Practice

    LUO Yuan1，2，XU Zhijie1，XIA Yu3，SHI Jiana4，JIANG Zhizhi2，ZHOU Xinmei1，ZHAO Yang5，6*，TONG Yuling1*

    1. Department of General Practice，the Second Affiliated Hospital，Zhejiang University School of Medicine，Hangzhou 310009，China

    2. Xiaoying Community Health Service Center of Shangcheng District，Hangzhou 310009，China

    3. Department of General Practice，Peking University Shenzhen Hospital，Shenzhen 518036，China

    4. Department of Pharmacy，Zhejiang Provincial People's Hospital(People's Hospital of Hangzhou Medical College)，Hangzhou 310014，China

    5. The George Institute for Global Health，University of New South Wales，Sydney 2050 ......